The Nobel prize for medicine or physiology, the Lasker award for clinical medicine, and the Gairdner international award are given to individuals for their role in developing theories, technologies and discoveries which have changed the direction of biomedical science. These distinctions have been used to develop an NLG metric to measure research performance and trends in ‘revolutionary’ biomedical science with the aim of identifying the premier revolutionary science research institutions and nations from 1992–2006. I have previously argued that the number of Nobel laureates in the biomedical field should be expanded to about nine per year and the NLG metric attempts to predict the possible results of such an expansion. One hundred and nineteen NLG prizes and awards were made during the past fifteen years (about eight per year) when overlapping awards had been removed. Eighty-five were won by the USA, revealing a massive domination in revolutionary biomedical science by this nation; the UK was second with sixteen awards; Canada had five, Australia four and Germany three. The USA had twelve elite centres of revolutionary biomedical science, with University of Washington at Seattle and MIT in first position with six awards and prizes each; Rockefeller University and Caltech were jointly second placed with five. Surprisingly, Harvard University – which many people rank as the premier world research centre – failed to reach the threshold of three prizes and awards, and was not included in the elite list. The University of Oxford, UK, was the only institution outside of the USA which featured as a significant centre of revolutionary biomedical science. Long-term success at the highest level of revolutionary biomedical science (and probably other sciences) probably requires a sufficiently large number of individually-successful large institutions in open competition with one another – as in the USA. If this model cannot be replicated within smaller nations, then it implies that such arrangements need to be encouraged and facilitated in multi-national units.

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I have previously argued that Nobel prizes (and other similar international awards and medals) may be used in scientometrics to measure research performance and trends in ‘revolutionary’ science [1]; with the aim of identifying the premier revolutionary science research institutions and nations [2].

Nobel prizes are typically awarded for theories, technologies and discoveries which have changed the direction of a science. By contrast, most successful scientific research is ‘normal science’ which represents a more incremental improvement on already existing work: normal science takes science further in an established direction rather than starting a new direction [1], [2] and [3].

Biomedical research currently constitutes the dominant world science in terms of volume, funding and prestige. I have argued that the number of Nobel laureates in the biomedical field (i.e. the prize in physiology or medicine, and sometimes chemistry) should therefore be expanded from the current maximum of three to a minimum of six, preferably nine, per year to recognize this dominance [2].

In the following analysis, I have attempted to predict the possible results of such expansion by creating a metric from Nobel prizes in physiology/medicine [4] and adding two other prestigious awards: the Lasker award for clinical medical research and the Gairdner international award; over a fifteen year time span of 1992–2006 inclusive.

The NLG metric

I recorded the national and institutional affiliations of Nobel laureates who received the prize for medicine or physiology during the period 1992–2006, affiliations were allocated for the time laureates received the prize [4]. Lasker and Gairdner awards were likewise noted for that period.

The approximately-annual Lasker Award for clinical medical research recognizes up to three scientists whose work pioneers a major improvement in clinical management or treatment [5]. Unlike the Lasker award for basic medical research, which frequently predicts a Nobel prize in Physiology/Medicine, the clinical medical research award does not frequently overlap with the Nobel prize. The Gairdner international award [6] is given to about six outstanding biomedical scientists per year, so the Gairdner award contributes about half the weight to this metric.

My impression is that early Gairdner awards considerably over-represented Canada (the award is administered from Toronto), and even now this probably still remains a small bias because Canada got five Gairdner awards (from the sixty-two included in this analysis) from 1992–2006, but no Nobels or Laskers. Therefore, I restricted this analysis to the past 15 years when the Gairdner seems to have functioned as a more validly ‘international’ award for merit. I also considered including in the revolutionary science metric the one-winner-per-year Lasker award for basic medical research, but there was such a high degree of overlap with the Gairdner award that this was omitted for the sake of simplicity and clarity.

Credit for the prize or award was given to the institution and nation to which the winner was affiliated at the time of the award (except where it was clear that the winner had moved in the past few months while awaiting the award). It would certainly be more valid to award credit to institutions and nations on the basis of where the prize- or award-winning research was actually accomplished, and I hope that future researchers will be able to do the investigative work needed to accomplish this.

Each individual scientist was counted only once, because a scientist who won more than one of these prizes and awards was credited for just one on the assumption that the Nobel is senior to the Lasker, and the Lasker is senior to the Gairdner. Credit for the prize or award was therefore given to the institution or nation to which the winner was affiliated at the time of the senior award or prize. Sometimes a Lasker or Gairdner award winner had also received a Nobel prize for chemistry (rather than medicine/physiology) – such individuals affiliations were allocated for the time of winning either the Lasker or Gairdner.

This process created a pool of one hundred and nineteen winners, which (over fifteen years) represents an average of about eight winners per year – about the number of annual laureates I recommended for the Nobel prize in medicine. As in previous analyses [7] and [8], I set a minimum threshold of three prizes or awards before an institution or nation qualified as a centre of revolutionary science, on the basis that one or two might be luck or coincidence, but three prizes/awards probably indicates systematic strength.

Measuring revolutionary science by counting such rare and highly-selective prizes and awards, and also of setting a minimum of three prizes and awards before a nation or institution registers as a significant centre, means that the NLG metric inevitably generates many false negatives. It must be presumed that many valuable centres of revolutionary science are not picked-up by this metric.

However, for the same reasons, the NLG metric is unlikely to generate many false positives; and the listed centres of revolutionary biomedical science can be assumed to deserve their elite status with a high degree of confidence – subject to the above caveats about the method of counting affiliations at the time of winning, rather than accomplishing the work which led-to winning, see Table 1 and Table 2.

Table 1.

Number of Nobel, Lasker, Gairdner (NLG) winners 1992–2005 by nation USA 85UK 16Canada 5Australia 4Germany 3A minimum of three winners is required for inclusion as a centre of revolutionary biomedical science.

Table 2.

Number of Nobel, Lasker, Gairdner (NLG) winners 1992–2005 by institution (all institutions are in the USA, excepting Oxford) MIT 6University Washington, Seattle 6 Caltech 5 Rockefeller University 5 NIH 4UCSF 4University Pennsylvania 4 Yale University 4 Columbia University 3Fred Hutchinson CRC, Seattle 3 Johns Hopkins 3Washington University, St. Louis 3 University of Oxford (UK) 3 A minimum of three winners is required for inclusion as a centre of revolutionary biomedical science. UCSF, University of California at San Francisco; CRC, Cancer Research Center.

NLG metric national and institutional analysis

The NLG metric national distribution (Table 1) reveals a massive dominance of the USA in revolutionary biomedical science, confirming the previous results of US domination for revolutionary science generally, and provides further confirmation of a trend that this US domination may be increasing [7] and [8]. The UK is a clear second, with a number of prizes and awards that is broadly in proportion to the population difference between the UK and the US. Canada, Australia and Germany also feature (although I am suspicious that Canada only qualifies by winning the Canadian-administered Gairdner award).

The finding of overwhelming US domination is particularly interesting when contrasted with the probability that the ‘rest of the world’ is probably catching-up with the USA in terms of ‘normal science’ metrics (with these metrics presumably dominated by biomedical research) such as numbers of publications and citations. For instance, the European Union nations and China, and some smaller far eastern nations (e.g. Taiwan, Souh Korea, Singapore), are probably increasing normal science production faster than the USA [9] and [10]. The implication is that only the USA has a research system which actively supports revolutionary science at the highest level [7] and [8].

The University of Washington at Seattle comes joint-top of the league table (Table 2) for revolutionary biomedical science (with MIT) which may surprise those observers who have failed to notice the rise to international prominence of this institution [7]. In a separate analysis of total Web of Science citations per US university, we also found that University of Washington was ranked fourth (after Harvard, Johns Hopkins and Stanford) [3]. So the clear implication is that University of Washington at Seattle should now be considered one of the truly elite research universities of the world, and that its pre-eminence is probably focused in biomedical science. Something similar also applies in relation to UCSF (University of California at San Francisco) [8]. It was also surprising to see the great strength of MIT in biomedical science, when this institution has traditionally been associated more with the physical sciences (and economics); and something similar applies to Caltech (joint second place) – which, unlike MIT (with Harvard), has no affiliated medical school.

Perhaps even more startling was the failure of Harvard to reach the threshold of three winners required in order to feature on this league table. During 1992–2006 Harvard achieved only two Gairdner awards and neither a Nobel prize for medicine nor a Lasker award. This confirms the relatively poor showing of Harvard in my previous analyses of performance in revolutionary science such as Nobel trends from 1947–2006 [7], and the analysis for the past 20 years which includes Fields medals, Lasker awards and Turing awards [8].

Yet during the past three decades Harvard has massively dominated all other institutions in the world in terms of scientific research production such as numbers of papers published and number of citations earned ([3], and unpublished results from Web of Science by Peter Andras and Bruce G Charlton, Newcastle University, UK). Also Harvard has topped the authoritative Shanghai Jiao Tong university table of world universities by a large margin since its inception in 2003 http://ed.sjtu.edu.cn/ranking.htm.

My interpretation of this overall picture is that, over recent decades, Harvard has failed to orientate its priorities towards the cutting-edge of the major dominant branch of world science. The institution has clearly been successful in maintaining massive productivity in very high quality ‘normal science’; but apparently has not encouraged the much riskier endeavours in the type of revolutionary biomedical science which wins major prizes, medals and awards.

Revolutionary biomedical science outside the USA

The University of Oxford is the only institution outside of the US which has won three prizes or awards in the past fifteen years and thereby ranks as a major centre of revolutionary biomedical science. This good performance of Oxford is in-line with that university’s increasingly emphasis on science (probably especially medical science) over recent decades, and its catching-up with its UK rival Cambridge and also with the US ‘Ivy League’ in terms of science production [11] and [12].

In the UK the other thirteen prizes and awards (outside of Oxford) are scattered across nine different institutions, so that less than twenty percent of UK NLGs were won by significant UK centres of revolutionary bioscience. This contrasts with the US picture where more than fifty percent of NLGs (fifty awards and prizes out of eighty-five) were won at major research institutions – representing a greater concentration of high level revolutionary science activity. This may well herald the evolutionary emergence of a separate research system of ‘pure medical science’, as we have previously advocated [13].

Due to the limitations of the Gairdner award more than fifteen years ago, I am unsure of the long-term UK trend in revolutionary biomedical science; but given that the UK seems to be declining as a centre of revolutionary science-in-general [7] it seems a plausible hypothesis that the US dominance in revolutionary science is a consequence of having revolutionary science concentrated in a relatively large number of individually significant and successful institutions. Furthermore, these elite US institutions are apparently in competition as judged by the rise to prominence of the University of Washington at Seattle and UCSF, and the decline of Harvard. Moreover, this is apparently an open competition since it has enabled new entrants to this status as well as relegation from this status.

However, it must be remembered that the NLG only measures the visible and most fully-validated tip of an iceberg of revolutionary science. These prizes and awards credit successful revolutionary science which has changed the direction of a discipline in a big way, and where credit for this can be allocated to a single person or a few individuals. It is almost certain, on general theoretical grounds derived from complex systems theory [14], that the process of generating major breakthroughs in revolutionary science must be supported by a much larger submerged base of revolutionary science research which is harder to identify with confidence, and where credit for achievements is more diffused between individuals.

The possible lesson for countries outside the US may be that long-term success at the highest level of revolutionary biomedical science (and probably other sciences) may require a sufficiently large number of sufficiently large and individually-successful institutions in open competition with one another. If this model cannot be replicated within smaller nations, then it implies that such arrangements need to be encouraged and facilitated in multi-national units, such as the European Union.

Acknowledgement

Thanks are due to Peter Andras whose conversation and collaboration fuelled this work.